- Penn Medicine (Lancaster, PA)
- …you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. + Experience working… more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Houston Methodist (The Woodlands, TX)
- …Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of department scores for ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance… more
- Baylor Scott & White Health (Dallas, TX)
- …management to provide services to members. + Keep updated on approved utilization management criteria, guidelines, and regulations. **Key Success Factors** + ... use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use treatment experience and/or behavioral… more
- BriteLife Recovery (Englewood, NJ)
- …compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials , approvals, and length-of-stay ... What you will be doing? The Utilization Review (UR) Specialist is a...you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization Review ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key role of...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- Baptist Memorial (Memphis, TN)
- …* The position may be filled in Memphis, TN; Jackson, MS The Denial Mitigation-Appeal Specialist II RN serves in a key role of the BMHCC revenue cycle as ... and denial resolution in order to defend our revenue. The Denial Mitigation-Appeal Specialist II RN reviews the denial received from the payer, completes a thorough… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will...to meet contractual obligations. + Coordinates execution of notices ( denials ) of non-coverage when appropriate and communicates with key… more
- Trinity Health (Troy, NY)
- …of possible concurrent denials , forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified process standards * ... Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization … more
- UnityPoint Health (Des Moines, IA)
- …+ Identifies training opportunities and p rovides training as needed to improve operations. Denials Management + Work with leadership and st aff to identify and ... Documentation + Shift: Days + Job ID: 166410 Overview Revenue Cycle Integrity Specialist Days, Full-time. No weekends or Holidays This position is open to… more
- Dana-Farber Cancer Institute (Brookline, MA)
- … Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services. ... preferred. + 1 year clinical and/or related experience required. + Case Management , Utilization Review, Oncology, Cellular Therapy and/or Prior Authorization… more
- Penn Medicine (Philadelphia, PA)
- …1500 Market Street Hours: M-F 8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system ... throughout the organization that requires coding and documentation knowledge. Assist Coding Management staff in performing quality audits on coding staff and assist… more
- UPMC (Pittsburgh, PA)
- UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position ... documentation within the medical record to ensure that all patient resource utilization , principal diagnosis, secondary diagnoses, and PCS procedures have been coded… more
- Sanford Health (Fargo, ND)
- …periods. Documents work in case management module; provides direction to utilization management , case management , and nursing regarding what action ... staff and clinic staff. **Job Summary** The Patient Access Specialist reviews and validates insurance eligibility, prior authorization and/or...needs to be taken. Collaborates with case management , social work, utilization management ,… more
- Highland Hospital (Rochester, NY)
- …benefits, identifies and resolves coordination of benefits discrepancies, and notifies Utilization Management of additional clinical requests **Salary Range:** ... **16795BR** **Title:** Health Insurance & Authorization Specialist I **Department/Cost Center:** 846 - Business Office/Cashiers...for correct level of care, inquires on prior auth denials and works with the Provider's office to resolve,… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary This position is located in the Health Information Management Section (HIMS) of the Business Service at the San Francisco VA Health Care System (SFVAHCS). ... a MRT (Coder-Outpatient). CDIS serves as the liaison between health information management and clinical staff. They are responsible for facilitating improved overall… more